Hemodynamic profile during laparoscopic cholecystectomy versus laparoscopic bariatric surgery: the impact of morbid obesity.

The present study investigated the hemodynamic profile using impedance cardiography (ICG) monitor during pneumoperitoneum for laparoscopic cholecystectomy versus bariatric surgery in order to determine the impact of body weight on hemodynamics. METHODS. 32 adult patients (two groups, each 16 patients) were studied. Group 1 (16 patients) scheduled to undergo laparoscopic cholecystectomy (lapchole) with body mass index (BMI) 28 +/- 5 kg/m2. Group 2 (16 patients) scheduled to undergo laparoscopic adjustable band (LAGB) surgery for treatment of morbid obesity with BMI 45.3 +/- 8 kg/m2. under general anesthesia. Besides routine monitoring, impedance cardiography was used for hemodynamic monitoring. Three stages were identified for statistical analysis A, pre-insufflation, B, during vere pneumoperitoneum and C, at gas deflation. RESULTS. The mean values of cardiac index in group 1 at stages A, B and C were, 3.0 +/- 1.7, 2.5 +/- 0.5 and 2.7 +/- 0.5 L/min/m2 respectively with significant low values in stage B compared to stage A (p < 0.05). The same trend continue in group 2 where the mean values were, 2.4 +/- 0.6, 1.8 +/- 0.6 and 2.3 +/- 0.9 L/min/m2 respectively with significant differences compared to group 1 mean values (p < 0.05). Other hemodynamic variables showed non-significant differences (p > 0.05). CONCLUSIONS. Cardiac index showed significant decreasing trend in morbid obese patients compared to nonobese, which may reflect the effect of body weight on hemodynamics. On the other hand other hemodynamic parameters was not altered by body weight. We believe that hemodynamics should be closely monitored during laparoscopic surgery with pneumoperitoneum.